Why Kaiser Permanente can wait for striking mental health workers

The day before his departure on strike, Jenny Butera checked her schedule. Butera, a marriage and family therapist, had a backlog of adult outpatients needing to be seen by her Kaiser Permanente office in downtown Sacramento. Despite days of counseling nearly a dozen of them in one-on-one sessions, one after another, nothing has eased the crisis.

The date on Butera’s calendar was August 14.

“My next first date,” Butera said, “was in mid-October. For anyone.

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For Butera and many of the roughly 2,000 members of the National Union of Health Workers whose strike began more than five weeks ago, action at work seemed right. It wasn’t about the money, she said; it was about improving a chronically understaffed workplace that often leaves patients waiting weeks or months between mental health appointments.

But NUHW members are hitting the same wall that many Kaiser mental health patients may already know too well. The tools they have to effect change are limited – and Kaiser’s resilience is real.

By midweek, Kaiser and the union were at an impasse in negotiations. A Kaiser spokesman, Marc Brown, told Capital & Main that 50% of striking mental health clinicians have returned to work, figures the union said it could not confirm because many of them work at distance. (Disclosure: NUHW is a financial backer of Capital & Main.)

“We know we’re going to see more people crossing the picket line, and that’s exactly why they’re waiting for us,” said Chelsea Wise-Diangson, initial access coordinator at Kaiser’s Department of Child and Adolescent Psychiatry. Santa Clara Homestead. Medical Center. “I was able to hold on, but I recognize my [financial] privilege to be able to do so.

While Kaiser officials blame the pandemic for dramatically increasing the need for mental health care services, the company has performed poorly in this area for years, according to industry experts.

Sources say the parties long ago agreed on a modest pay rise. But one of the remaining sticking points is huge: Striking health workers want Kaiser to agree in writing to a plan that improves patient-to-staff ratios and ensures patients can be seen earlier in therapy follow-up sessions. . So far, it’s a non-starter.

It’s not just a wish; it’s the law. When Senate Bill 221 went into effect on July 1, it filled a critical gap in California’s mental health care systems. Companies like Kaiser are now required to schedule a patient’s follow-up appointment within 10 days of their last visit, unless the professional treating the patient thinks a longer wait will not be harmful.

Before the bill became law, the 10-day rule only applied to people requesting their first visit; there was no obligation to schedule a next session in due time. The rule applies to all insurers and state health insurance plans, but it clearly targets behemoths like Kaiser, which has a long history of inadequate mental health services and has paid millions of dollars in fines for overbooking of its therapists.

Yet almost nothing has changed, with wait times for follow-up appointments regularly between four and eight weeks, according to therapists. While Kaiser officials blame the pandemic for dramatically increasing the need for such services, the company performed poorly in this area for years before COVID-19 hit, industry experts say.

As the strikers find out, it takes a lot to move Kaiser. Once the NUHW industrial action began, the company portrayed union members as demanding to spend less time with patients – “Our patients cannot afford a proposal that drastically reduces the time available for s ‘looking after them and their mental health needs,'” Brown said in a statement — while contracting with outside providers to take some of their long-delayed appointments. Butera was told that Kaiser had offered extremely high rates of pay for short-term outside help, although Capital & Main could not confirm the figures.

“Our current position is clear. We won’t sign a contract unless Kaiser puts it in writing that he will obey the law,” Butera said. “They can do that. There are plenty of therapists working and available – they just won’t work for Kaiser.

“We cannot keep staff to save our lives. We’ve been pretty perpetually understaffed, and especially in the last couple of years.

~Chelsea Wise-Diangson, Kaiser Therapist

Kaiser’s mental health services crisis is not a new story. In May, the state’s Department of Managed Health Care (DMHC) announced a “non-routine investigation” to investigate the extent of the company’s shortcomings in providing these services to its patients. Kaiser has about 9.4 million Californians enrolled in health plans.

Ultimately, it may take a combination of state and labor actions to exert enough pressure on Kaiser to improve his outreach to his own mental health patients, as the numbers themselves do not add up for a profit-driven HMO through its separate medical groups. According to health economists, it is much cheaper for Kaiser to absorb occasional fines, which he can manage easily; the company recorded $8.1 billion in net revenue last year and has $52 billion in reserves.

If Gov. Gavin Newsom signs SB 858, which increases penalties from $2,500 to $25,000 for individual violations of things like timely access to care and adequate network standards, the pressure could increase. Beyond that, the DMHC conducts health provider audits every three years. It also handles individual complaints about access – but in this case, those depend on patients contacting the state agency themselves as they try to deal with their own mental health issues. urgent.

The department also has the authority to move to enforcement, including “requiring corrective action, issuing administrative penalties, using cease and desist orders, or suspending/revoking a license,” the department’s spokeswoman said. DMHC, Rachel Arrezola. But these are extreme measures that would evolve over a period of years, not conducive to the urgent need to improve mental health services at this time.

All of this begs the question of what can be done to get Kaiser to act like the healthcare provider its ads proclaim. At Wise-Diangson’s office, “We can’t keep staff to save our lives,” she said. “We’ve been pretty perpetually understaffed, and especially in the last couple of years.”

The balance of Kaiser patients cannot be calculated. For the therapists and clinicians who work with them and try to help them, burnout is rampant. Wise-Diangson said five strikers in his Santa Clara department recently returned to their offices, two of them so they could complete the paperwork to quit the company.

On September 30, she will join them. “I cannot ethically, morally go back to Kaiser,” Wise-Diangson said. In the meantime, the strike continues, with no resolution in sight. Just as he has with state penalties and fines in the past, Kaiser can afford to stay loyal.

Copyright 2022 Capital & Main

Why Kaiser Permanente can wait for striking mental health workers

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